title: Restoration of virginity: women's demand and health care providers' response in Switzerland.
abstract: BACKGROUND
  As a result of transnational migration, health institutions are faced with growing demand for "restoration" of virginity. The practice of hymen reconstruction constitutes a challenge for health care providers in medical, ethical, judicial, social, and cultural dimensions, for which they are not well prepared.
  
  
  OBJECTIVE
  The aim of the presented nationwide survey was to investigate the experience of Swiss gynecologists with women requesting hymen reconstruction.
  
  
  METHODS
  A questionnaire specifically designed for this purpose was sent to 100 public hospitals.
  
  
  METHODS
  Main outcome measures included demands for (number of requests, origin of women) and attitudes toward hymen reconstruction (requests granted, decision-making for or against intervention, surgical technique applied, problems associated with the requests for hymen repair, cost coverage, need for further information) in Switzerland.
  
  
  RESULTS
  The response rate was 68%. Of the 43 clinics (63.2%) confronted with requests for hymen reconstruction, 38 (90.5%) claimed to see up to five patients per year. The predominantly mentioned countries of origin were Turkey in the German-speaking part and Arab countries in the French-speaking part. More than half of the clinics (27/64.3%) reported that they always (12/28.6%) or mostly (15/35.7%) granted the request. Decision for surgery was made after intensive counseling in 44.2% and on demand of the patient after brief counseling in 32.7%. The so-called approximation method was the most frequently applied surgical technique. A third of the participants (19/35.2%) reported problems with confidentiality. More than half of the clinics expressed their need for further information on this topic.
  
  
  CONCLUSIONS
  Hymen reconstruction is rarely performed in Switzerland, even though two-thirds of the responding hospitals are confronted with this issue several times per year. No guidelines exist on how health professionals should deal with these requests. Interdisciplinary research on how to meet the needs of women and health care providers in such cross-cultural encounters is needed.
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Basel, Basel, Switzerland.
authors.forename: Sibil
authors.initials: S
authors.lastname: Tschudin
authors.forename: Sylvie
authors.initials: S
authors.lastname: Schuster
authors.forename: Denise
authors.initials: D
authors.lastname: Dumont dos Santos
authors.forename: Dorothy
authors.initials: D
authors.lastname: Huang
authors.forename: Johannes
authors.initials: J
authors.lastname: Bitzer
authors.forename: Brigitte
authors.initials: B
authors.lastname: Leeners
mesh_terms: D003430:Cross-Sectional Studies; D003466:Cultural Characteristics; D004641:Emigration and Immigration; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology; D006301:Health Services Needs and Demand; D006779:Hospitals, Public; D006801:Humans; D006924:Hymen / Q000601:surgery*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000191:economics / Q000706:statistics & numerical data*; D012746:Sexual Abstinence / Q000208:ethnology / Q000523:psychology; D013557:Switzerland
keywords: Cosmetic Surgery; Genital Plastic Surgery; Hymen Reconstruction; Hymen Repair; Hymenorrhaphy; Restoration of Virginity